Industry facing headwinds in a 'perfect storm' of disruption, says Change Healthcare

A new survey with the HealthCare Executive Group sees trends such as consumerism and social determinants forcing providers and payers to fundamentally rethink how care is delivered and reimbursed.
By Mike Miliard
02:19 PM

One in three healthcare executives surveyed for a new report from Change Healthcare say they're convinced that healthcare is set to be significantly changed by companies and technologies coming from outside of healthcare.

WHY IT MATTERS
That's not the only trendline they think could impact existing processes and business models, according to the new Industry Pulse study from Change and HealthCare Executive Group, which polled nearly 200 healthcare decision-makers.

These leaders say their organizations – beyond the day-to-day challenges of managing AI, analytics and cybersecurity – are grappling with a rapid pace of change as shifting imperatives and new players make for a reshaped landscape.

If consumer-focused companies are changing the equation, so are consumers themselves, the report shows, with C-suite members saying that increased consumer demand and empowerment is opening the door for new competitors who could do better at giving them the access, convenience and cost transparency they seek.

Still, perhaps one of the biggest and most talked-about changes is still a ways off, according to those interviewed. For all the discussion of accountable care and its impacts, almost 40 percent of those polled said they felt "a market in which the majority of value-based relationships include both upside and downside shared-risk remains three to five years off," according to Change Healthcare.

That said, healthcare organizations are already positioning themselves for a near-term future where patient experience and population health management are essential to success. This is especially true, researchers found, with regard to social determinants of health, with a "significant number of respondents planning to offer programs addressing care coordination, transportation, food insecurity, and other factors for members over the next 12 months."

The most common approach to integrating SDOH (18.4 percent) was coordination with existing community programs and resources. Also cited by some health systems was the ability to offer social assessments alongside the health risk assessments (15.1 percent), as well as the integration of non-medical information – financial status and educational attainment – with clinical data (13.9 percent).

Still, challenges remain for social determinant use, said researchers: "The lack of payment structures for non-medical approaches lead the way at 49.2 percent. Medicare is reimbursing for some of these measures, and the industry may follow suit – or not. Some 48.7 percent of respondents cited a lack of effectiveness metrics for non-medical solutions; 42.9 percent named limitations on data sharing. These are prerequisites to more widespread adoption of these practices."

THE LARGER TREND
Not every healthcare provider is yet incorporating social determinant data in their pop health efforts, but many those who are have seen them pay dividends – not just in healthier patient populations, but also in their own reimbursement and revenue.

SDOH is still a new phenomenon, relatively speaking, and the incentives haven't been in place long to encourage more widespread use of that data. Still, the arrival of value-based reimbursement, slow and incomplete as it may be so far, is proving their value and making social determinants more mainstream. What's needed next, as we've shown, is a personalized and quantifiable approach to their measurement to demonstrate true ROI.

ON THE RECORD
"Outside influences are intensifying," said researchers. "A confluence of forces – people, processes, and technology – will require healthcare to turn to new business models and market strategies. Most notable among these are non-healthcare entrants to the marketplace, whose consumer-centric innovations could help re-imagine patient engagement."

“Healthcare is navigating disruptions on multiple fronts, and as a consequence, payers and providers are finding themselves stretched thin as they try to address a perfect storm of change," added David Gallegos, senior vice president of consulting services at Change Healthcare, in a statement.

"As if insurance market changes, value-based care, consumerization, and regulatory uncertainty weren’t enough, this year the industry is facing a new breed of market entrants and innovators whose impact remains unknown but could be substantial," said Gallegos. "Even the largest healthcare organizations don’t have the people and processes to move on all these fronts alone, yet they can’t ignore these changes."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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